Healthcare Provider Details

I. General information

NPI: 1164776340
Provider Name (Legal Business Name): ALLEN KAMRAVA, MD MBA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2012
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N BEDFORD DR STE 308
BEVERLY HILLS CA
90210-4380
US

IV. Provider business mailing address

435 N BEDFORD DR STE 308
BEVERLY HILLS CA
90210-4380
US

V. Phone/Fax

Practice location:
  • Phone: 424-279-8222
  • Fax: 424-279-8226
Mailing address:
  • Phone: 424-279-8222
  • Fax: 424-279-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA103694
License Number StateCA

VIII. Authorized Official

Name: DR. ALLEN KAMRAVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 424-279-8222